Healthcare Provider Details

I. General information

NPI: 1992092175
Provider Name (Legal Business Name): DARLA LEIGH MARRIOTT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DARLA LEGIH TERRY

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S 26TH AVE
OMAHA NE
68131
US

IV. Provider business mailing address

PO BOX 2797
OMAHA NE
68103-2797
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-3198
  • Fax: 402-354-3199
Mailing address:
  • Phone: 402-354-4230
  • Fax: 402-354-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112776
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: